Letter to the Editor: “An Alternative Approach to Determining Metabolic Syndrome Component Cutoffs in Children and Adolescents Using Segmental Regression Analysis”

To the Editor:

Previously in this Journal, Circulation Reports, we proposed cutoffs for metabolic syndrome components using data from elementary and junior high school students throughout Japan.¹ Subsequently, we considered that cutoffs for high school adolescents using the same method would be similarly valuable. Therefore, we analyzed data from high school health examinations in the same manner as previously reported.¹

The participants were 1,296 high school volunteers (571 boys and 725 girls) in Kagoshima, Toyama, and Chiba prefectures, who enrolled between 2006 and 2008. Participant characteristics (mean±standard deviation) for boys and girls, respectively, were as follows: age (years), 16.5±0.9 and 16.7±0.9; height (cm), 170.5±5.8 and 158.4±5.2; weight (kg), 61.8±11.0 and 51.6±7.0; and body mass index (kg/m²), 21.3±3.5 and 20.5±2.5. The prevalence of obese students who were ≥20% overweight was 11.4% for boys and 4.7% for girls. The 2007 School Health Statistics Survey reports values for obese students of 12.9% and 9.2%, respectively, showing a slight bias toward thinness among female participants.

The results are shown in Table. Breakpoint values of waist circumference and blood pressure were larger compared with junior high school students.¹ Those of triglycerides varied regardless of age and sex.¹ Those of high-density lipoprotein cholesterol and fasting blood glucose were similar to those for other age groups.¹ Based on these results, we proposed cutoffs for high school students. However, further study is needed to determine whether these cutoffs can be applied generally throughout Japan.

Table.

Metabolic Syndrome Components of High School Students in Japan

	Mean	Breakpoint value [Breakpoint percentile]	Our proposed cutoff
WC (cm)
Boys	73.0 (8.8)	81.4 [89]	82
Girls	71.2 (6.3)†	81.5 [94]
SBP (mmHg)
Boys	117 (10)	133 [96]	135
Girls	107 (9)†	119 [91]	120
DBP (mmHg)
Boys	63 (9)	75 [90]	75
Girls	62 (9)†	74 [92]
TGs (mmol/L)
Boys	0.59 [0.41/0.84]*	1.05 [86]	1.36 (120 mg/dL)
Girls	0.58 [0.44/0.78]*	1.63 [98]
HDLC (mmol/L)
Boys	1.55 (0.31)	1.14 [7]	1.17 (45 mg/dL)
Girls	1.71 (0.35)†	1.19 [5]
FBG (mmol/L)
Boys	4.88 (0.39)	5.33 [89]	5.27 (95 mg/dL)
Girls	4.77 (0.33)†	5.22 [93]

Data are expressed as mean (standard deviation). *Skewed data are expressed as the median [25th/75th percentiles]. ^†P<0.05, boys vs. girls using Student’s t-test. DBP, diastolic blood pressure; FBG, fasting blood glucose; HDLC, high-density lipoprotein cholesterol; SBP, systolic blood pressure; TGs, triglycerides; WC, waist circumference.

Sources of Funding

The present study was supported by a grant provided by the Health and Labour Sciences Research Grant from the Ministry of Health, Labour, and Welfare of Japan (H18-049).

IRB Information

The Ethics Committee of the National Hospital Organization Kagoshima Medical Center (No. 18)

Data Availability

The deidentified participant data will not be shared.

• Ayumi Miyazaki, MD, PhD
• Department of Pediatrics, Japan Community Healthcare Organization Takaoka Fushiki Hospital, Takaoka, Japan
• Masao Yoshinaga, MD, PhD
• Department of Pediatrics, National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan
• Masaki Shinomiya, MD, PhD
• Chiba Medical Association, Chiba, Japan
• Hiromitsu Ogata, PhD
• Epidemiology and Biostatistics, Kagawa Nutrition University, Sakado, Japan

Reference

• 1.   Miyazaki A, Yoshinaga M, Ogata H, Ito Y, Aoki M, Kubo T, et al. An alternative approach to determining metabolic syndrome component cutoffs in children and adolescents using segmental regression analysis. Circ Rep 2024; 6: 118–126.